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Meta-Analysis
. 2024 Jul 5;24(1):730.
doi: 10.1186/s12909-024-05720-8.

Effectiveness of virtual and augmented reality for cardiopulmonary resuscitation training: a systematic review and meta-analysis

Rao Sun  1 , Yixuan Wang  2 , Qingya Wu  1 , Shuo Wang  1 , Xuan Liu  1 , Pei Wang  1 , Yuqin He  1 , Hua Zheng  3   4
Affiliations
Meta-Analysis

Effectiveness of virtual and augmented reality for cardiopulmonary resuscitation training: a systematic review and meta-analysis

Rao Sun et al. BMC Med Educ. .

Abstract

Background: Virtual reality (VR) and augmented reality (AR) are emerging technologies that can be used for cardiopulmonary resuscitation (CPR) training. Compared to traditional face-to-face training, VR/AR-based training has the potential to reach a wider audience, but there is debate regarding its effectiveness in improving CPR quality. Therefore, we conducted a meta-analysis to assess the effectiveness of VR/AR training compared with face-to-face training.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang databases from the inception of these databases up until December 1, 2023, for randomized controlled trials (RCTs) comparing VR- and AR-based CPR training to traditional face-to-face training. Cochrane's tool for assessing bias in RCTs was used to assess the methodological quality of the included studies. We pooled the data using a random-effects model with Review Manager 5.4, and assessed publication bias with Stata 11.0.

Results: Nine RCTs (involving 855 participants) were included, of which three were of low risk of bias. Meta-analyses showed no significant differences between VR/AR-based CPR training and face-to-face CPR training in terms of chest compression depth (mean difference [MD], -0.66 mm; 95% confidence interval [CI], -6.34 to 5.02 mm; P = 0.82), chest compression rate (MD, 3.60 compressions per minute; 95% CI, -1.21 to 8.41 compressions per minute; P = 0.14), overall CPR performance score (standardized mean difference, -0.05; 95% CI, -0.93 to 0.83; P = 0.91), as well as the proportion of participants meeting CPR depth criteria (risk ratio [RR], 0.79; 95% CI, 0.53 to 1.18; P = 0.26) and rate criteria (RR, 0.99; 95% CI, 0.72 to 1.35; P = 0.93). The Egger regression test showed no evidence of publication bias.

Conclusions: Our study showed evidence that VR/AR-based training was as effective as traditional face-to-face CPR training. Nevertheless, there was substantial heterogeneity among the included studies, which reduced confidence in the findings. Future studies need to establish standardized VR/AR-based CPR training protocols, evaluate the cost-effectiveness of this approach, and assess its impact on actual CPR performance in real-life scenarios and patient outcomes.

Trial registration: CRD42023482286.

Keywords: Augmented reality; Basic life support; Cardiopulmonary resuscitation; Meta-analysis; Systematic review; Virtual reality.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection
Fig. 2
Fig. 2
Risk of bias summary. Green represents a low risk of bias, yellow some concerns, and red a high risk of bias
Fig. 3
Fig. 3
Forest plot for chest compression depth
Fig. 4
Fig. 4
Forest plot for chest compression rate
Fig. 5
Fig. 5
Forest plot for overall CPR performance score
Fig. 6
Fig. 6
Forest plot for proportion of participants meeting CPR guidelines’ depth criteria
Fig. 7
Fig. 7
Forest plot for proportion of participants meeting CPR guidelines’ rate criteria
See this image and copyright information in PMC

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